How much stress is too much and what can you do about it?

Covid-19 taught most people that the line between tolerable and toxic stress defined as persistent demands that lead to illness varies greatly. But some people will age faster and die younger from toxic stressors than others.

So how much stress is too much, and what can you do about it?

I am a psychiatrist specializing in psychosomatic medicine, which is the study and treatment of people suffering from physical and mental illnesses. My research focuses on people with psychological conditions and medical illnesses, as well as those whose health problems are exacerbated by stress.

I have spent my career studying mind-body questions and training clinicians to treat mental illness in primary care settings. My next book is titled Toxic Stress: How Stress is Killing Us and What We Can Do About It.

A 2023 study on stress and aging across the lifespan, one of the first studies to confirm this common wisdom, found that four measures of stress accelerate the pace of biological aging in middle age. It also found that persistent high stress ages people in ways comparable to the effects of smoking and low socioeconomic status, two well-established risk factors for accelerated aging.

Good stress, bad stress

A good stress, demand or challenge that you deal with easily is good for your health. In fact, pacing these daily challenges, like feeding yourself, cleaning up messes, communicating with each other, and getting work done, helps regulate your stress response system and keep you fit. .

Toxic stress, on the other hand, wears out your stress response system in a way that has lasting effects, as psychiatrist and trauma expert Bessel van der Kolk explains in his best-selling book. The body keeps score.

The first effects of toxic stress are usually persistent symptoms such as headache, fatigue, or abdominal pain that interfere with general functioning. After months of initial symptoms, a full-blown illness with a life of its own can appear, such as migraines, asthma, diabetes or ulcerative colitis.

When we are healthy, our stress response systems are like an orchestra of organs that miraculously tune and play in unison without our conscious effort, a process called self-regulation. But when we’re sick, parts of this orchestra struggle to regulate themselves, causing a cascade of stress-related dysregulation that contributes to other conditions.

For example, in the case of diabetes, the hormonal system struggles to regulate sugar. With obesity, the metabolic system has difficulty regulating energy intake and consumption. With depression, the central nervous system develops an imbalance in its circuits and neurotransmitters that makes it difficult to regulate mood, thoughts, and behaviors.

Stress treatment

While the neuroscience of stress in recent years has given researchers like me new ways to measure and understand stress, you may have noticed that in your doctor’s office, stress management typically it is not part of your treatment plan.

Most doctors do not assess the contribution of stress to common chronic diseases in patients such as diabetes, heart disease and obesity, in part because stress is difficult to measure and in part because it is difficult to treat . Doctors generally don’t treat what they can’t measure.

Neuroscience and the epidemiology of stress have also recently taught researchers that the chances of developing serious mental and physical illnesses in midlife increase dramatically when people are exposed to trauma or adverse events, especially during vulnerable periods such as childhood. .

Over the past 40 years in the United States, the alarming rise in rates of diabetes, obesity, depression, PTSD, suicide, and addictions points to one contributing factor that these disparate diseases share: toxic stress.

Toxic stress increases the risk of onset, progression, complications or early death from these diseases.

Suffering from toxic stress

Because the definition of toxic stress varies from person to person, it’s hard to know how many people struggle with it. A starting point is the fact that around 16% of adults report having been exposed to four or more adverse events during childhood. This is the threshold for increased risk of disease in adulthood.

Research dating back to before the Covid-19 pandemic also shows that about 19% of adults in the US have four or more chronic diseases. If you have even one chronic illness, you can imagine how stressful four must be.

And about 12% of the US population lives in poverty, the epitome of a life where demands exceed resources every day. For example, if a person does not know how they will get to work each day, or does not have a way to fix a leaky water pipe or resolve a conflict with their partner, their stress response system does not can you ever rest One or any combination of threats can keep them on high alert or shut them down in a way that prevents them from trying to cope.

Add to these overlapping groups all those who struggle with abusive relationships, homelessness, captivity, severe loneliness, who live in high-crime neighborhoods or work around noise or air pollution. It seems conservative to estimate that about 20% of people in the US are living with the effects of toxic stress.

Stress management

The first step in managing stress is to recognize it and discuss it with your primary care physician. The doctor may do an assessment that includes a self-reported measure of stress.

The next step is treatment. Research shows that it is possible to retrain a dysregulated stress response system. This approach, called lifestyle medicine, focuses on improving health outcomes by changing high-risk health behaviors and adopting everyday habits that help the stress response system to self-regulate

Adopting these lifestyle changes isn’t quick or easy, but it works.

The National Diabetes Prevention Program, the Ornish UnDo heart disease program, and the US Department of Veterans Affairs’ PTSD program, for example, achieve a decrease or reversal of chronic stress-related conditions through weekly support groups and guided daily practices over six to nine months. . These programs help teach people how to practice personal stress management, diet, and exercise regimens so that they build and maintain their new habits.

There is now strong evidence that it is possible to treat toxic stress in ways that improve health outcomes for people with stress-related conditions. Next steps include finding ways to expand recognition of toxic stress and, for those affected, expanding access to these new and effective treatment approaches.

Lawson R Wulsin is a professor of psychiatry and family medicine at the University of Cincinnati.

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